| BackgroundFemale infertility rate is increasing in resent years, which is mainly caused by fallopian tube abnormal occlusion or adhesion called tubal factor infertility (TFI). Normal oviduct plays an important role in pregnancy responsible for picking up the ovum, sperm and early embryos transporting, and applying the place for normal fertilization. Therefore, it is important to establish the screening and diagnosis tools for following treatment and better prognosis. Many methods have been de-scribed to evaluate tubal condition for example hysterosalpingography (HSG), laparoscopy or laparoscopy combined with hysteroscopy; however, there is no consistent system to evaluate in clinical to date nor is the comprehensive guideline for TFI patients followed by the certain di-agnostic method.ObjectiveTo establish a tubal evaluation system in clinical by assessing the prognosis of TFI patient who has been received oviduct reconstruction surgery (salpingoplasty).Materials and methodsTFI patients with salpingoplasty admitted to the Gynecology and Obstetrics Hospital of Fudan University during 1998-2007 and 2010-2011 were chosen as the subject in this study. A Self-designed follow-up questionnaire was used to collect information including medial history, collecting ex-surgery information and post-surgery information by phone. Data analysis was performed with Log-rank test, Fisher’s exact test, Kaplan-Meier, Cox’s proportional hazards regression model (univariate analysis and multivariate analysis) and likelihood ratio test.ResultsTotally 1241 TFI patients were included during 1998-2007 in this study. Subjects who completed follow-up total 464 people (37.39%), who done salpingoplasty by TV-Laparoscopy, and the population distributes within 2003 to 2007. Loss follow-up totals 777 people (62.61%). The average age of completed follow-up is 29.8±4.03 years old, minimum is 20 years old, and maximum is 44 years old. The ratio of gravidity:0 time is 31.5%, 1 time is 37.7%,2 times is 20.3%,3 times is 7.8%,4-6 times is 2.8%. The ratio of infertility history is 47.4%. The average years of infertility history is 4.15±3.36years. The ratio of pelvic inflammation history is 11.9%. The ratio of ectopic pregnancy history is 7.8%. The ratio of ovarian lesion history is 1.3%. The ratio of abortion history is 4.3%. The ratio of IVF-ET is 2.8%. The ratio of appendectomy history is 6.4%. The ratio of cesarean section is 1.3%. The ratio of other surgery history is 0%. The ratio of IUD contraception history is 7.5%. The condition of two years after operation:uterine pregnancy total 128 people (27.6%), ectopic pregnancy totlal 52 people (11.2%), and unpregnancy total 284 people (61.2%). IVF-ET within 2 years after surgery total 52 people (11.2%). (Table 1)Totally 698 TFI patients were included during 2010-2011 in this study. Subjects who completed follow-up total 513 people (73.5%), loss follow-up totals 185 people (26.5%). The average age of completed follow-up is 30.1 ±4.43 years old, minimum is 20 years old, and maximum is 44 years old. The ratio of gravidity:0 time 42.7%,1 time 33.7%,2 times 15%,3 times 5.3%,4-6 times 3.3%. The ratio of infertility history is 2.53%. The average years of infertility history is 3.7+2.72years. The ratio of ectopic pregnancy history is 8.6%. The ratio of ovarian lesion history is 1.2%. The ratio of abortion history is 40%. The ratio of IVF-ET is 2.7%. The ratio of IUD contraception history is 3.8%. (Table 3) The condition of two years after operation:uterine pregnancy total 140 people (38.6%), ectopic pregnancy total 21 people (56.8%), and unpregnancy total 202 people (55.6%). The pregnant outcome:awaiting delivery total 6 people, spontaneous abortion total 9 people, artificial abortion total 3 people, nature labour total 37 people (30.3%), caesarean section total 85 people (69.7%,49 people (57.6%) chosen by their will). According the first time of IVF-ET after surgery, IVF-ET in 5-7 months after surgery total 15 people, average times is 1.33 times. The outcome:uterine pregnancy total 12 people, unpregnancy total 3 people, and ectopic pregnancy total 0 people. IVF-ET in 11-13 months after surgery total 30 people, average times is 1.83 times. The outcome:uterine pregnancy total 17 people, unpregnancy total 11 people, and ectopic pregnancy total 2 people. IVF-ET in 24-36 months after surgery total 38 people, average times is 1.57 times. The outcome:uterine pregnancy total 24 people, unpregnancy total 14 people, and ectopic pregnancy total 0 people.In this study, there are some relations between ex-surgery search during operation and the rate of pregnancy as follows:the range of adhesion in pelvic cavity (no>widely; partially>widely), the quality of bilateral oviducts adhesion (no>>embranous>condense), the range of bilateral oviducts adhesion (no>partial ovary>all ovary), the shape of tubal fimbria structure (well structured>partially structured>impaired), the shape of bilateral oviducts (well structured>partially struc-tured>impaired) and the patency of bilateral oviducts (not pa-tent>obstructed; extremely not patent>obstructed). Others conditions might have bias because of its interaction.ConclusionsThe incidence of TFI patients in the studied population increased from 124.1 to 349 (person/year) during 1998-2007 and 2010-2011 respectively.Interaction has been observed in the oviduct adhesion, the shape of tubal fimbria and the patency of bilateral oviducts when the prognosis of surgery was viewed as outcome. (Table 6)According to the pregnancy rate curve, the Tubal Evaluation System classified the pregnancy conditions into five statistically significant categories, forming the five grades in guideline:Grade 1 (Good), IVF-ET is suggested in 12-24 months after post-operation-visiting (POV), and passive followed-up should be avoided. Grade 2 (Moderate), IVF-ET is suggested in 12-18 months after POV, and passive followed-up should be avoided. Grade 3 (Worse), IVF-ET is suggested in 6-12 months after POV, passive followed-up should be avoided. Grade 4 (Worsen-Worst), IVF-ET is suggested in 6-12 months after POV, and active follow-up is required. And Grade 5 (Worst), IVF-ET is suggested in 6-8 months after POV, and active follow-up is required.In conclusion, the evaluation system in this study assesses the fallopian tubal condition by grading into five levels, providing an important hint for prognosis after surgery. |
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